CONFIDENTIAL PERSONAL PROFILE

304 N. Main Street

Greer, SC 29650

864.879.0337 – fax 864.879.0373

Please complete & return by fax or mail. Someone from our office will contact you to schedule your initial appointment, upon receipt of your information. Please print clearly. If you are not sure, leave blank. It’s OK to approximate amounts.

IMPORTANT: Please include a copy of your most recent investment/401(k)/IRA/Social Security statements.

You were referred to our office by: ______Date: ____/____/____

Name:______Nickname:______Date of Birth:______

Spouse Name: ______Nickname: ______Date of Birth: ______

Mailing Address:______Street Address: ______

City______State ______Zip ______

Home Phone:______Cell Phone: ______Business Phone: ______

Email Address: ______

Employer and Occupation: ______Salary: ______

Spouse Employer/Occupation:______Salary: ______

Do you have other sources of income? Y ___ N ___ If so, what are the sources & amounts? (please attach list)

Children (names/ages/school): ______

______

Do you have college savings / UTMA accts / 529 accts for children? Y ___ N ___ (please include copies of stmts)

Have you heard of Christian Financial Counselor & Radio Host, Dave Ramsey? Y ___ N ___ If so:

Please list any events you have attended (FinancialPeaceUniversity, Live Event, etc) or books you have read (The Total Money Makeover, Financial Peace Revisited, More than Enough, etc): ______

______

Where are you on your “Baby Steps”? ______

Does your family follow a monthly written cash flow plan/budget? Y __ N __ (if so, please attach copy of your current plan; if not, are you interested in talking with our Dave Ramsey Certified Counselor to assist you in this area? Y __ N __)

What does your family spend per month to meet your necessary living expenses (food, housing/utilities, transportation, clothing)? $______

Do you keep an emergency fund in a savings or money market? Y ___ N ___ Amount: $______

Planned retirement date: ____/____/____ or if retired, date retired: ____/____/____

Do you currently own Home Care &/or Nursing Home Insurance? Y ___ N ___ Ins. Co. ______

Securities offered through LPL Financial. Member FINRA/SIPC

CONFIDENTIAL PERSONAL PROFILE – page 2

Are you participating in your company 401(k)/retirement plan? Y ___ N ___ Are you receiving guidance on your 401(k) investments? Y ___ N ___ Please describe your plan/matching contributions & attach copies of your latest statements & all investment choices: ______

______

Do you currently have a financial advisor? Y ___ N ___

What is your family’s approximate net worth (total assets minus total debts)? ______

Current Debts: Please attach a list of your current debts (home mortgage, vehicle(s), credit cards, 401(k) loans, etc), including interest rate, value of home/vehicle(s), remaining balance, monthly payment, & number of years remaining on each.

Life Insurance: Please complete the following & attach a copy of your latest life insurance statements. We will complete a life insurance needs analysis & provide guidance during your appointment.

Company / Name of Insured / Type of Ins (term, whole, var, etc) / Death Benefit / Cash Value & Loan Amount
1. / $ / $
2. / $ / $

If married, do both of you make decisions when it comes to investing/saving/insurance/etc in your household?

Y ___ N ___ If not, who? ______

How do you prefer to be communicated with? (frequency/method): ______

______

Please list your top 3 objectives for life / financial goals / concerns / wishes:

  1. ______
  1. ______
  1. ______

What is the primary reason you would like to schedule an appointment with our office? ______

______

Roger, Jason or Alex will ask you a number of additional questions concerning your goals and concerns during your initial appointment. They will keep the appointment to an hour, and go over how the office team works with clients, fees, and services. Following the appointment, they will likely ask that you set another appointment to come back in to review our analysis and financial plan for your life goals. Our plan is to make your life easier by providing a road map to reach your goals and wishes – retirement/asset protection/retirement income/college savings/etc. You are under no obligation, and the appointment is free.

The foregoing information fully reflects an accurate picture of my financial position at this time

SIGNATURE: ______SPOUSE: ______Date: ___/___/___

Securities offered through LPL Financial. Member FINRA/SIPC